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2009 flu pandemic
The 2009 flu pandemic or swine flu was an influenza pandemic that lasted from early 2009 to late 2010, and the second of the two pandemics involving H1N1 influenza virus (the first of them being the 1918–1920 Spanish flu pandemic), albeit in a new version. First described in April 2009, the virus appeared to be a new strain of H1N1 which resulted when a previous triple reassortment of bird, swine and human flu viruses further combined with a Eurasian pig flu virus, leading to the term "swine flu". It is estimated that 11–21% of the global population contracted the illness, and 151,700–575,400 died. Unlike most strains of influenza, H1N1 does not disproportionately infect adults older than 60 years; this was an unusual and characteristic feature of the H1N1 pandemic. Even in the case of previously very healthy people, a small percentage will develop pneumonia or acute respiratory distress syndrome (ARDS). This manifests itself as increased breathing difficulty and typically occurs three to six days after initial onset of flu symptoms. The pneumonia caused by flu can be either direct viral pneumonia or a secondary bacterial pneumonia. In fact, a November 2009 New England Journal of Medicine article recommended that flu patients whose chest X-ray indicates pneumonia receive both antivirals and antibiotics. In particular, it is a warning sign if a child (and presumably an adult) seems to be getting better and then relapses with high fever, as this relapse may be bacterial pneumonia. History Initially coined an "outbreak", the stint began in the state of Veracruz, Mexico, with evidence that there had been an ongoing epidemic for months before it was officially recognized as such. The Mexican government closed most of Mexico City's public and private facilities in an attempt to contain the spread of the virus; however, it continued to spread globally, and clinics in some areas were overwhelmed by infected people. In June, the World Health Organization (WHO) and the U.S. CDC stopped counting cases and declared the outbreak a pandemic. The onset of the pandemic coincided with a severe financial crisis triggered by the bursting of the US housing bubble, which has been compared in its severity to the Great Depression of the 1930s. Both events (pandemic and financial crisis) become entangled. Despite being informally called "swine flu", the H1N1 flu virus cannot be spread by eating pork or pork products; similar to other influenza viruses, it is typically contracted by person to person transmission through respiratory droplets. Symptoms usually last 4–6 days. Antivirals (oseltamivir or zanamivir) were recommended for those with more severe symptoms or those in an at-risk group. The pandemic began to taper off in November 2009, and by May 2010, the number of cases was in steep decline. On 10 August 2010, the Director-General of the WHO, Margaret Chan, announced the end of the H1N1 pandemic, and announced that the H1N1 influenza event has moved into the post-pandemic period. According to the latest WHO statistics (July 2010), the virus has killed more than 18,000 people since it appeared in April 2009, however they state that the total mortality (including deaths unconfirmed or unreported) from the H1N1 strain is "unquestionably higher". Critics claimed the WHO had exaggerated the danger, spreading "fear and confusion" rather than "immediate information". The WHO began an investigation to determine whether it had "frightened people unnecessarily". A flu followup study done in September 2010, found that "the risk of most serious complications was not elevated in adults or children." In an 5 August 2011 PLoS ONE article, researchers estimated that the 2009 H1N1 global infection rate was 11% to 21%, lower than what was previously expected. However, by 2012, research showed that as many as 579,000 people could have been killed by the disease, as only those fatalities confirmed by laboratory testing were included in the original number, and meant that many of those without access to health facilities went uncounted. The majority of these deaths occurred in Africa and Southeast Asia. Experts, including the WHO, have agreed that an estimated 284,500 people were killed by the disease, much higher than the initial death toll. Health response On 27 April 2009, the European Union health commissioner advises Europeans to postpone non-essential travel to United States or Mexico. This followed the first discovery of confirmed case in Spain. On 7 May 2009, the WHO said that the containment is not feasible and countries should mitigate the effect of the virus. They did not recommend closing the borders or travel. On 26 April 2009, the Chinese government announced that visitors returning from flu-affected areas who experienced flu-like symptoms within two weeks would be quarantined. Some non-U.S. airlines, mostly Asian, including Singapore Airlines, China Eastern Airlines, China Southern Airlines, Cathay Pacific and Aeromexico, took measures such as stepping up cabin cleaning, installing state-of-the-art air filters and allowing in-flight staff to wear face masks. Schools U.S. government officials have been especially concerned about schools because the H1N1 flu virus appears to disproportionately affect young and school-age people, between six months and 24 years of age. The H1N1 outbreak led to numerous precautionary school closures in some areas. Rather than closing schools, the CDC recommended that students and school workers with flu symptoms should stay home for either seven days total, or until 24 hours after symptoms subsided, whichever was longer. The CDC also recommended that colleges should consider suspending fall 2009 classes if the virus began to cause severe illness in a significantly larger share of students than the previous spring. They also urged schools to suspend rules, such as penalties for late papers or missed classes or requirements for a doctor's note, to enforce "self-isolation" and prevent students from venturing out while ill; schools were advised to set aside a room for people developing flu-like symptoms while they waited to go home and to have ill students or staff and those caring for them use face masks. 2009 flu pandemic timeline Singapore The 2009 flu pandemic in Singapore was an influenza pandemic involving the influenza A virus subtype H1N1. It was part of an epidemic that occurred in 2009 of the H1N1 virus, causing what was commonly known as swine flu. Prior to the H1N1 outbreak in Singapore, there already existed a disease surveillance system and influenza pandemic preparedness plan. Known as the Disease Outbreak Response System (DORS), it is a five-colour alert system that progresses from green to yellow, orange, red and black. In response to the H1N1 outbreaks, the Singapore Ministry of Health (MOH) took precautionary health measures to contain the spread of the virus to Singapore. These health control measures included contact tracing, the issuing of Home Quarantine Orders (HQO), travel advisories, public health advisories (temperature screening at schools, public and commercial places including border checkpoints and screening for flu-like symptoms for visitors to hospitals), treatment and vaccination. Singaporeans were also reminded to ensure a high standard of personal hygiene. On 28 April 2009, MOH raised the alert mode from green to yellow (an indication of the situation when the virus evolves into a human disease) for the first time, and then two days later to orange. MOH then revised it downwards to yellow on 11 May. At that time, there were no confirmed cases of infection in Singapore. Singapore confirmed its first case of H1N1 in late May 2009. The patient, a 22-year-old Singapore Management University student, had travelled from New York back to Singapore on 26 May and had developed a cough while on the flight. She passed the airport thermal scanner without incident as she did not have a fever at the time. Later that morning, she consulted a doctor who sent her to Tan Tock Seng Hospital via a 993 ambulance, given her travel history. She was immediately admitted for testing, after which laboratory confirmation of her infection was made by midnight of 26 May. MOH initiated contact tracing of her close contacts, who were quarantined, and provided with antiviral prophylaxis. By 23 June, there were 194 human cases of H1N1 in Singapore. To ensure that Singaporeans had ready access to medical assessment and prompt treatment for mild cases of H1N1, more than 400 family clinics island-wide were made H1N1-ready. Supplies of Personal Protection Equipment and the Tamiflu vaccine were made available at these Pandemic Preparedness Clinics. As of 7 July 2009, there were 1,217 confirmed cases. On 18 July, a 49-year-old man with heart problems became the first person to die after being infected with the H1N1 virus. The victim, who had multiple health problems, died of a heart attack complicated by severe pneumonia and the H1N1 infection. The virus outbreak appeared to peak by August, with attendances at clinics dropping off for the first time in weeks. The 18th and last H1N1 fatality of the year, in September, was a 61-year-old man with a history of diabetes, hypertension and end-stage renal failure. Then Health Minister Khaw Boon Wan assured that the supply of the H1N1 vaccine ‘should be enough’. By year-end of 2009, one million does were available. On 17 October 2009, there were 18 confirmed deaths from H1N1 virus in Singapore. On 12 February 2010, the Health Ministry changed its alert level to green. By this time, it was estimated that 415,000 people in Singapore had been infected with the H1N1 virus and more than 420,000 local residents had received the H1N1 vaccine injection. Most infected persons in Singapore experienced mild illness, while there were more than 1,600 hospital admissions from complications related to the virus, including about 100 admissions to intensive care. Two weeks after the alert status turned Green, a 5-year old boy with no underlying medical conditions died from the virus infection at the KK Women's and Children's Hospital. The Singapore Communicable Disease Centre (CDC) conducted a study on the H1N1 virus from June to October 2009, before, during and after the H1N1 epidemic. Released in April 2010, the report found that most adults in Singapore remain vulnerable to the H1N1 virus as only 13 percent of the population has natural immunity to it. Singaporeans were advised to get vaccinations against both H1N1 as well as the seasonal flu. Though mild, the H1N1 virus continues to be the predominant influenza strain in Singapore and globally. Overall, influenza activity in Singapore remains at low to moderate levels. While most people with H1N1 recover with rest and treatment, infection with the virus can result in hospitalisation or even death, especially in those with underlying medical conditions such as asthma, diabetes, gross obesity or low immunity, or in those who are pregnant.